Trauma I Flashcards
Cerebral Edema= excessive ____ in the brain
fluid
Vasogenic Edema:
- Disrupted ____-____ _____
- Examples – around hemorrhages and tumors; infections
blood brain barrier
Cytotoxic Edema:
- Increased _______ fluid
- Example – hypoxic/ischemic injury, osmotic disequilibrium – dialysis or _____, _____-osmotic states - SIADH
Cytotoxic Edema:
- Increased intracellular fluid
- Example – hypoxic/ischemic injury, osmotic disequilibrium – dialysis or DKA, hypo-osmotic states - SIADH
Interstitial Edema:
- Increased ______ (ventricular) pressure pushes fluid across _____layer
- Example – area adjacent to enlarged _____ in hydrocephalus
Interstitial Edema:
- Increased intracranial (ventricular) pressure pushes fluid across ependymal layer
- Example – area adjacent to enlarged ventricles in hydrocephalus
With edema morphology, the brain is _____ and ____.
With edema morphology, the brain is enlarged and softened.
As a result of edema morphology, the following can occur:
- Increased intracranial pressure
- Flattening of ______
- Compression of ventricular cavities
- Herniation
- Neurologic symptoms
- Headaches
- Vomiting
- Papilledema
As a result of edema morphology, the following can occur:
- Increased intracranial pressure
- Flattening of gyri
- Compression of ventricular cavities
- Herniation
- Neurologic symptoms
- Headaches
- Vomiting
- Papilledema
What does this image show?
cerebral edema:
An acute stroke (left) is characterized by edema. The infarcted side is larger than the opposite hemisphere.
what does this image show?
Cerebral Edema:
cerebral abcesses surrounded by edema
What does this image show?
The edema appears as a dark rim around the central tumor on CT.
Mechanism of herniation: _____brain pushes brain through ____
Mechanism of herniation: expanding brain pushes brain through opening
What are the consequences of the mechanism of herniation?:
- _____ of structures/deficits
- Vascular compromise
- Ischemia
- Hemorrhage
What are the consequences of the mechanism of herniation?:
- Compression of structures/deficits
- Vascular compromise
- Ischemia
- Hemorrhage
Transtentorial Herniation:
- Supratentorial lesion forces brain through ______ notch
- Compression of _____ nerve
- Duret hemorrhage in midbrain/upper ___ secondary to downward displacement of the______ (and fixed penetrating vessels)
- Compression of opposite cerebral _____ (Kernohan notch)
Transtentorial Herniation:
- Supratentorial lesion forces brain through tentorial notch
- Compression of 3rd nerve
- Duret hemorrhage in midbrain/upper pons secondary to downward displacement of the brainstem (and fixed penetrating vessels)
- Compression of opposite cerebral peduncle (Kernohan notch)
Subfalcian herniation:
- Lateral cerebral hemisphere lesion forces brain under ____
- Compression of _____ cerebral arteries possible
Subfalcian herniation:
- Lateral cerebral hemisphere lesion forces brain under falx
- Compression of anterior cerebral arteries possible
Cerebellar tonsillar herniation:
- Often secondary to ______ _____lesion
- Brain forced down through foramen _____
- _____centers compromised – Apnea and death
Cerebellar tonsillar herniation:
- Often secondary to posterior fossa lesion
- Brain forced down through foramen magnum
- Respiratory centers compromised – Apnea and death
What does this image show?
Uncal herniation is seen with supratentorial masses forcing the uncal region down through the tentorial notch.
What does this image show?
Tonsillar herniation
What does this image show?
Duret Hemmorhage:
As the uncus and brainstem are pushed downward, penetrating vessels become stretched and break. This leads to hemorrhages in the upper pons, Duret hemorrhages, that can be fatal.
What does this image show?
Duret hemorrhage
What type of trauma is a gunshot through the brain?
penetrating
What type of trauma is it when the head strikes the floor or a dashboard?
Blunt trauma
What type of trauma is it when the skull is disrupted?
open trauma
What type of trauma is it when the skull is intact and you have internal lesions?
closed trauma
A concussion is what type of injury?
Parenchymal
Contusion is what type of injury?
parenchymal
Laceration is what type of injury?
parenchymal
Diffuse axonal damage is what type of injury?
Parenchymal
Hematomas are what type of injury?
vascular damage injury
Do concussions have physical damage?
no
What is contusion?
bruising
Types of contusion:
Coup –____ lesion
Contrecoup – on _____side of brain
Types of contusion:
Coup – under lesion
Contrecoup – on opposite side of brain
Shearing of axons can occur through ____ or ___
acceleration or deceleration
What areas are most at risk for axonal damage?
midline white matter areas (around corpus callosum)
Diastatic fractures occur across ____
sutures
Basilar fractures – At ____ of brain; can lead to ____ eyes (pooling of blood around eyes/orbit) or _____hematomas; ____ cranial nerves can be compromised
Basilar fractures – At base of brain; can lead to raccoon eyes (pooling of blood around eyes/orbit) or mastoid hematomas; lower cranial nerves can be compromised
Concussion
- Follows trauma with no _____ physical damage
- Damage/changes may be _______
- Associated with brief loss of consciousness and transient amnesia
- Severity varies from very mild to severe
- Much attention with sports injuries
- Repeated concussions increase chance of permanent brain damage.
Consussion
- Follows trauma with no observable physical damage
- Damage/changes may be biochemical
- Associated with brief loss of consciousness and transient amnesia
- Severity varies from very mild to severe
- Much attention with sports injuries
- Repeated concussions increase chance of permanent brain damage.
Contusion
- Bruise with local vascular damage and resultant ischemia; worse at _____ of gyri
- Occurs at area of injury (coup) or opposite to area of injury (contrecoup) often opposite areas of rough/irregular skull (e.g. base of ____ and ____lobes)
- Coup (at site of injury) often occur when head is _____ and receives a blow
- Contrecoup (opposite site of injury) often occur when head is _____ and collides with surface.
- Often ____ lesions are often present.
Contusion
- Bruise with local vascular damage and resultant ischemia; worse at crests of gyri
- Occurs at area of injury (coup) or opposite to area of injury (contrecoup) often opposite areas of rough/irregular skull (e.g. base of temporal and frontal lobes)
- Coup (at site of injury) often occur when head is immobile and receives a blow
- Contrecoup (opposite site of injury) often occur when head is mobile and collides with surface. Often coup lesions are often present.
What do these images show?
contusions
What does this image show?
Acute contusions show evidence of the hemorrhages. Contrecoup lesions are often located on the temporal horns or inferior frontal lobes (i.e. opposite rough and irregular skull).
Epidural vascular injury/hemorrhage:
- Tear of middle meningeal artery by _____skull fracture
- Increase in volume and possible herniation and death more ____than other forms; often following _____ interval
Epidural vascular injury/hemorrhage:
- Tear of middle meningeal artery by temporal skull fracture
- Increase in volume and possible herniation and death more rapid than other forms; often following lucid interval
Subdural vascular injury/hemorrhage
- Tear of_______veins (cortex to sagittal sinus)
- More common in _____ (greater distance between brain and sinus)
- Accumulation of blood _____ than epidural
- Bilateral chronic subdurals can be associated with _____
Subdural vascular injury/hemorrhage
- Tear of bridging veins (cortex to sagittal sinus)
- More common in elderly (greater distance between brain and sinus)
- Accumulation of blood slower than epidural
- Bilateral chronic subdurals can be associated with dementia
Subarachnoid/Intraparenchymal vascular injury/hemorrhage
- With contusions and lacerations
- Secondary to tearing of _____ blood vessels
Subarachnoid/Intraparenchymal vascular injury/hemorrhage
- With contusions and lacerations
- Secondary to tearing of small blood vessels
What does this image show?
epidural hemorrhage
What does this image show?
Subdural Hemorrhage
What does this image show?
Subarachnoid Hemorrhage
